Gabriel Y El-Hage Boutrous, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3718 Issued in OH

Practice address

4565 Dressler Rd NW
Suite LL 21
Canton, OH 44718-2549

Phone

(330) 491-9700

Fax

(330) 491-9730

NPI assigned

Apr 21, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Professional Care, LLCGroup PAC ID 7416857198, 53 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Medical Center Hospital, Canton, OH, CCN 360070

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mercy Professional Care, LLC

  • Internal Medicine Physician
  • Canton, OH
  • NPI 1902827876
  Medicare reassignment Care Compare group NPD
• Cleveland Clinic Mercy Hospital

  • General Acute Care Hospital
  • Canton, OH
  • NPI 1366433195
  Medicare reassignment NPD
• New Horizons Psychiatric Counseling and Pain Management Services LLC

  • Psychiatry Physician
  • Canton, OH
  • NPI 1861597148
  NPD (past)
• S Zaidi MD and Associates Inc

  • Psychiatry Physician
  • Canton, OH
  • NPI 1518987361
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cleveland Clinic Mercy Hospital

  • General Acute Care Hospital
  • Canton, OH
  • NPI 1366433195
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193961600000",
    "number": "1285690040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4565 DRESSLER RD NW",
            "address_2": "SUITE LL 21",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182549",
            "telephone_number": "330-491-9700",
            "fax_number": "330-491-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4565 DRESSLER RD NW",
            "address_2": "SUITE LL 21",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182549",
            "telephone_number": "330-491-9700",
            "fax_number": "330-491-9730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EL-HAGE BOUTROUS",
        "first_name": "GABRIEL",
        "middle_name": "Y",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2007-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "3718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0685290",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Eisenbrei
• Tammy Lynn Eisentrout, D.O.
• Betsy D Ekey, PA-C
• Ahmed A El Ghamry Sabe, MD
• Bahaeddin A. El Khatib, M.D.
• Madison Elavsky
• Greggory Nicholas Elefterin, DDS
• Elevate Chiropractic and Wellness, LLC
• John Elgersma, MD
• Catherine E. Elkins, RN

• Psychologist in Canton, OH
• Providers in Canton, OH by specialty
• Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.